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Hirohiko Nakamura’s message to doctors is clear: Back off.

The president of a just-launched trade group of nursing-care providers, Nakamura said he is afraid that doctors are trying to burden the new public nursing-care insurance system with the troubles of the medical insurance system. He is also concerned that their role in the screening process for care recipients might introduce favoritism.

Some services already planned for the nursing-care system should be properly categorized as medical services and covered by medical insurance, said Nakamura, who also runs a nursing home in Tokushima Prefecture.

Gearing up for the start of the new system in April, the Nippon Care Manager Support Association was established last month by 2,600 nursing-care business owners around the country to mount an organized front to lobby the government. Two top priorities are to stop doctors from saddling the public nursing-care system with medical costs and to push an objective system — invulnerable to human foibles — to evaluate the needs of the elderly.

Nakamura is confident that lawmakers have every reason to listen to the association. “We will be able to mobilize enough votes to influence the fate of candidates in at least 100 of 300 single-seat districts in the coming general election,” he said.

Under the new system, people age 40 and over are required to pay a monthly premium, the amount of which varies in different municipalities, and eligible people 65 and over can receive coverage on 90 percent of their nursing-care services.

According to Nakamura, the largest concern of care providers is that the system may be dominated by medical professionals instead of nursing-care workers. He said he fears funds intended for the nursing-care insurance system could be siphoned off to support the financially strapped public medical insurance program.

Services at medical facilities for the elderly will be covered under the new system. That has increased the average premium by 70 percent, Nakamura said. While admitting the current premium — averaging about 3,000 yen — is not so high, he fears a further hike will undermine public support.

As for the standards for the elderly to receive care, Nakamura proposes a system that would prevent favoritism.

The qualification process, now under way in each municipality, has recently been spotlighted by media stories citing criticism that some applicants are getting away with overstating their needs.

To receive public services, the elderly must apply to municipal health authorities, who judge eligibility in two stages.

First, a nursing-care worker is dispatched to the applicant’s home to check the person’s overall condition according to a nationally standardized 85 questions.

The information obtained is then processed by computer software, which was developed by the Health and Welfare Ministry, to grade each applicant’s nursing needs on a seven-level scale.

A panel of about five welfare and medical experts make the final judgment based on the computer result in combination with opinions written by the applicant’s doctors and reports by nursing-care workers who asked the questions.

The elderly categorized as the most needy can receive up to 358,300 yen worth of services per month.

Nakamura said such panels, usually headed by doctors, significantly influence applicants’ evaluations, leaving open the possibility of arbitrary decisions.

He called on the qualification process to be transparent and objective, leaving no room for doubt, by using a system invulnerable to undue influence, such as a computer system.

However, Nakamura said there are still flaws to be mended in the first stage before computer analysis can be relied on as the sole decider.

For instance, the computer software tends to give low-need evaluations for those with senile dementia, he said, even when applicants’ conditions suggest a higher need for care.

He said it is the product of a system that puts too much weight on physical conditions of the elderly and too little on the mental. The questionnaire reflects this bias, he said.

Nakamura is frustrated to see some at his nursing home denied insurance benefits, forcing them to leave within a five-year grace period. With the scant supply of care facilities overwhelmed by the growing demand, those who are judged to be in no need for care cannot stay at nursing homes under the new system, even if they are willing and able to cover the fee by themselves.

The government, while introducing this new public nursing-care program in an attempt to deal with Japan’s rapidly graying population, remains timid in mapping out policies that might run counter to the interests of the Japan Medical Association — one of the biggest election machines.

But when Nakamura was asked if the Japan Medical Association was his group’s rival, he said: “No. Actually, I think they are more nervous about us.”

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